Incidence and Predictors of Hearing Aid Use and Ownership Among Older Adults With Hearing Loss

Purpose

The reasons are not clear as to why people who need hearing aids and possess them do not use them. We aimed to describe the incidence and predictors of hearing aid ownership and use among older adults.

Methods

We included 2,015 Blue Mountains Hearing Study participants aged ≥55 years who were examined between 1997 and 1999 and 2002 and 2004. Hearing levels were measured with pure-tone audiometry.

Results

The 5-year incidence of hearing aid use and ownership was 8.1% and 8.5%, respectively. Age was associated with incident hearing aid ownership and use, multivariable-adjusted odds ratio (OR) per decade increase in age of 1.79 (95% confidence interval [CI], 1.21–2.64) and of 1.66 (95% CI, 1.15–2.40), respectively. Any level of hearing loss (HL) at baseline predicted a 2.8-fold increased likelihood of using a hearing aid at follow-up. Hearing handicap was associated with 7% increased likelihood of incident aid use. Key reasons provided for not obtaining/using a hearing aid were: not recommended one (8.0%), its high cost (1.7%), and believing that they did not need one (9.0%).

Conclusions

Incident hearing aid ownership and usage was relatively low among hearing impaired adults. Age, question-defined hearing handicap, and measured HL were significant predictors of incident hearing aid use/ownership.

Introduction

Sensorineural age-related hearing loss (HL) is the most common form of hearing impairment (1), with reported prevalence between 30% and 46% of older population-based samples 2, 3. The strong age-related increase in HL prevalence (4) creates a significant burden not only for persons with this condition, but also for people who communicate with them (5). A diminished ability to hear and communicate is frustrating, and impacts on the affected individuals as well as other people in their environment (6). It is not therefore surprising that HL is associated with many adverse effects, including poor quality of life 7, 8, increased reliance on community or family support (9), negative well-being 7, 10, 11, depressive symptoms 12, 13, 14, and increased mortality risk (15).

There is an accumulating body of evidence to show that amplification devices such as hearing aids may improve the ability to communicate and thus, improve quality of life, prevent social isolation and hearing-related depression 11, 16, 17, 18, 19. Despite the known benefits of hearing aids, only a small fraction, between 10% and 30% of hearing impaired older adults actually use a hearing aid 7, 19, 20. Furthermore, a significant number of older adults who possess aids do not use them regularly (19). This proportion has not changed in recent years, despite innovations that have produced improvements in hearing aid technology (21). In the Blue Mountains Hearing Study (BMHS), of those with measured HL only 11% owned a hearing aid. Of persons who were current hearing aid owners, 24% reported never using their aids (22). These findings imply that the barriers to increasing the effectiveness and uptake of hearing aids encompass more than an inadequate device (23). These potential barriers include severity of HL, attitudes and personality characteristics, subjective perceptions of benefit, costs, cognitive and functional restrictions, and sociodemographic factors 21, 24.

Previous research that has estimated the prevalence of hearing aid ownership and actual use 7, 19, 20, has not comprehensively considered a full range of factors associated with the use of these devices (24). Second, there is a lack of prospective data on this association and much of the existing research is based on smaller, clinical-based samples of older adults, which may be less representative of the general population 24, 25. In the current study, we used a large, community-based sample of adults aged 55 years and older to address these gaps by establishing the (a) 5-year incidence of hearing aid use and ownership and (b) factors associated with incident hearing aid use and ownership. These data are potentially useful in developing intervention strategies that increase hearing aid penetration and benefit.